Journal Article

People with HIV Have More Noncalcified Cardiac Plaque

BOTTOM LINE 

Those with HIV have an increased risk of cardiovascular disease. A study using CT (computed tomography) compared those with and without HIV for the frequency of calcium deposits in coronary artery plaques.  An interesting finding was that persons with HIV were 2-3 times more likely to have noncalcified coronary plaques and less calcium deposits when compared to those without HIV. In other populations persons with such noncalcified coronary plaques had higher rates of major cardiac events. For asymptomatic persons with HIV, the results of CT of plaques in the coronary arteries could be helpful in encouraging the patient to reduce risk factors that are associated with cardiovascular disease.

ABSTRACT

Background

People living with HIV (PLWH) have a higher risk of myocardial infarction. Coronary atherosclerotic plaque CT characterization helps to predict cardiovascular risk.

Purpose

To measure CT characteristics of coronary plaque in PLWH without known cardiovascular disease and healthy volunteers without HIV.

Materials and Methods

In this prospective study, noncontrast CT (all participants, n = 265) was used for coronary artery calcium (CAC) scoring in asymptomatic PLWH and healthy volunteers without HIV, without known cardiovascular disease, from 2012 to 2019. At coronary CT angiography (n = 233), prevalence, frequency, and volume of calcified, mixed, and noncalcified plaque were measured. Poisson regressions were used with adjustment for cardiovascular risk factors. 

Results

There were 181 PLWH (mean age, 56 years ± 7; 167 men) and 84 healthy volunteers (mean age, 57 years ± 8; 65 men) evaluated by using noncontrast CT. CT angiography was performed in 155 PLWH and 78 healthy volunteers. Median 10-year Framingham risk score was not different between PLWH and healthy volunteers (10% vs 9%, respectively; P = .45), as were CAC score (odds ratio [OR], 1.06; 95% CI: 0.58, 1.94; P = .85) and overall plaque prevalence (prevalence ratio, 1.07; 95% CI: 0.86, 1.32; P = .55) after adjustment for cardiovascular risk. Noncalcified plaque prevalence (prevalence ratio, 2.5; 95% CI: 1.07, 5.67; P = .03) and volume (OR, 2.8; 95% CI: 1.05, 7.40; P = .04) were higher in PLWH. Calcified plaque frequency was reduced in PLWH (OR, 0.6; 95% CI: 0.40, 0.91; P = .02). Treatment with protease inhibitors was associated with higher volume of overall (OR, 1.8; 95% CI: 1.09, 2.85; P = .02) and mixed plaque (OR, 1.6; 95% CI: 1.04, 2.45; P = .03).

Conclusion

Noncalcified coronary plaque burden at coronary CT angiography was two- to threefold higher in asymptomatic people living with HIV without known cardiovascular disease compared with healthy volunteers without HIV.

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